People who use weight-loss drugs keep much more weight if they exercise after they stop taking the drug than those who don't.
Newer weight-loss drugs that suppress appetite and reduce appetite may be quite effective in helping people lose weight, with many people losing at least 10 or 20 percent of their weight while using them.
But in the real world, despite the effectiveness of these drugs, studies have shown that up to half of users give up on these drugs within a year, perhaps due to high cost,** or other reasons.
After that, the weight almost always quietly returns, and more worryingly, the weight that people regain is almost entirely fat and little muscle. As a result, their body's metabolic condition, which is usually before the use of the drug, may be less healthy than before.
But a major new long-term study of people who used and then stopped a weight-loss drug showed that there was a simple and feasible way to prevent unhealthy weight** after stopping the drug: exercise.
In this study, people who used weight-loss drugs maintained more weight after stopping the drugs than those who didn't exercise, and they retained more muscle.
Signe S Rensen Torekov, a professor of biomedical sciences at the University of Copenhagen in Denmark and lead author of the new study, said the findings strongly suggest that people who use these drugs may be able to "maintain a healthy weight," even after stopping the drugs. "But they do need to get exercise. ”
There is a condition for weight loss
Most obesity experts agree that the "holy grail" of healthy, long-term weight loss is maintenance. Losing weight in the short term is possible for many people. And it seems almost impossible to maintain weight.
These new generations of GLP-1 diabetes or weight-loss drugs, such as Ozempic, Wegovy, Zepbound and Mounjaro, appear to be exacerbating this dynamic. GLP-1 is an abbreviation for glucagon-like peptide 1 agonist; These drugs mimic the effects of GLP-1.
Most people lose weight rapidly while using these medications. But if you stop using it, weight usually regains almost quickly.
But is this ** inevitable?
Torekov and colleagues devised a multi-year, multifaceted effort to find out.
The study began with 195 Danish adults who were obese but did not have other major medical conditions. They were placed on a very low-calorie diet under the supervision of scientists to quickly lose about 30 pounds of weight. Since this is a weight maintenance study, scientists expect them to lose weight quickly and then transition to the maintenance phase.
During the retention phase, the researchers assigned some of these volunteers to start using Saxenda, commonly known as liraglutide, an early GLP-1 drug, to see if the drug helped them maintain or even increase their dieting weight. Saxenda is made by Novo Nordisk, which also produces two similar drugs — the diabetes drug Ozapik and the weight-loss drug Vegovy.
The study was funded in part by Novo Nordisk, a charitable organization associated with the Saxenda manufacturer. The pharmaceutical companies themselves did not monitor the study or its results, a company spokesperson said. ）
Another group of volunteers also started on the same medication, but also on a supervised exercise program with half-hour group indoor cycling sessions and 15 minutes of high-intensity full-body resistance training twice a week, as well as two home jogging or similar exercises. This exercise is mostly strenuous and means that people can barely talk while exercising.
The control group did not exercise and received a placebo instead of liraglutide. (Although saxenda's prescribing information says it should be used in conjunction with a low-calorie diet and increased physical activity, this recommendation is often ignored.) ）
After a year, almost everyone who took the drug maintained a lower weight or lost more weight.
Those who used both drugs and exercise lost the most. They lose about six pounds more than those who just take the drug, and more of that weight is fat than muscle.
What happens after the drug is stopped
The researchers published the results in the New England Journal of Medicine in 2021. Then, they began to study the most revealing part. They stopped everyone's medication and exercise sessions and left people on their own to maintain or regain weight.
A year has passed, and the researchers invite all volunteers back to the lab. 109 people returned, and researchers examined their weight, body composition, and current exercise habits.
For some, the year has been frustrating. Those who had previously only taken weight-loss medication without exercising had regained 70% or more of their body weight since the study began. Most of these regained weight is fat, not muscle, so they end up with a relatively high percentage of body fat.
They gained weight in an unhealthy way, "said Torekov.
But those who exercised while taking the drug maintained more weight loss during this phase. Many people were at least 10 percent lighter than at the start of the study, and some of the weight they regained was muscle, making their body composition healthier than the other groups.
You only need to exercise for two hours a week
Torekov says it's easy to understand why people who exercise gain less weight after stopping the drug. "They are still exercising," and they usually still volunteer to do a few hours a week even without the supervision or encouragement of scientists.
Hotspot Engine Program These findings suggest that "about two hours of strenuous exercise per week" may be a good goal to prevent weight ** after stopping weight-loss medications, she continues. It is best to mix aerobic and resistance exercises.
At the same time, those who only take medication without exercising are now almost entirely sedentary, averaging less than 30 minutes of exercise per week.
Earlier and after, more people who didn't exercise complained of fatigue during and after, which may have contributed to their current inactivity, Torekov said.
Overall, these results strongly demonstrate "the importance of adding exercise to regimens that include GLP-1 medications," said Daniel Drucker, a diabetes expert and researcher at the Lumenfeld-Tanenbaum Institute in Toronto, whose research helped pave the way for GLP-1 drugs. He was not involved in the new study.
Robert Kushner, an endocrinologist and weight-loss expert at Feinberg School of Medicine at Northwestern University, said: "These results are very encouraging," "but further research is needed to see if weaker exercise programs" have similar weight-loss maintenance effects after people stop GLP-1 medications.
There are other limitations to this study. It uses liraglutide, which is not as potent as more recent weight-loss medications. But Drucker said, "I expect the results of the latest GLP-1 drug to be similar in the direction." ”
It also involves relatively healthy Danes who may not be representative of others who wish to **. And in the first year, the workout routine studied wasn't just strenuous and it could be challenging. And it's free and closely supervised throughout the first year, which is a luxury for many.
But for now, the study tells us that in order to prevent weight ** and maintain muscle during and after the use of weight-loss drugs, "it's really important to have an exercise program," says Torekov.